January, 2009 What IHE Delivers1

Showcasing Showcasing InteroperabilityInteroperability

National Center for Public Health Informatics (NCPHI)National Center for Public Health Informatics (NCPHI)

Monthly Partner CallMonthly Partner Call

Lori Fourquet e-HealthSign LLCLori Fourquet e-HealthSign LLC

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What is “Integrating the Healthcare Enterprise”?What is “Integrating the Healthcare Enterprise”?

A 10-year public-private initiative A 10-year public-private initiative

Driven by end-users, IHE improves patient care by Driven by end-users, IHE improves patient care by harmonizing electronic health information exchange harmonizing electronic health information exchange

Enables approved standards to seamlessly pass health Enables approved standards to seamlessly pass health information among care providers on a local, regional and information among care providers on a local, regional and national levelnational level

IHE Frameworks are freely available to allIHE Frameworks are freely available to all

The IHE Global Standards Adoption process as approved The IHE Global Standards Adoption process as approved by the International Standards Organization (ISO) as a by the International Standards Organization (ISO) as a Technical Report 28380 in August 2007Technical Report 28380 in August 2007

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Proven Standards Adoption ProcessProven Standards Adoption Process

Document Use Case RequirementsDocument Use Case Requirements

Identify available Identify available standards (standards (e.g. HL7, e.g. HL7, DICOM, IETF, OASIS)DICOM, IETF, OASIS)

Identify available Identify available standards (standards (e.g. HL7, e.g. HL7, DICOM, IETF, OASIS)DICOM, IETF, OASIS)

Develop technical specifications

Develop technical specifications

Testing at ConnectathonsTesting at Connectathons

IHEDemonstrationsIHEDemonstrations

Products with IHEProducts with IHE

Timely access to informationTimely access to information

Easy to integrate productsEasy to integrate products

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International Growth of IHEInternational Growth of IHE

France

Local DeploymentNational ExtensionsPromotional & Live Demonstration EventsFunding

USA

Germany

Italy

JapanUK

Canada

Korea

Taiwan

Norway

Netherlands

SpainChina

Austria

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99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

88

Pragmatic global standards harmonization + best practices sharing Pragmatic global standards harmonization + best practices sharing

Australia

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IHE, global standards-based profiles adopted by IHE, global standards-based profiles adopted by several national & regional projectsseveral national & regional projects

Quebec, Toronto,Alberta, British Columbia

Canada Infoway

Denmark (Funen)Italy (Veneto)Spain (Aragon)

NCHICA – N. Carolina

Italy (Conto Corrente

Salute)

Boston Medical

Center - MA

FranceDMP

UK CfH(Radiology WF)

Philadelphia HIE

CHINA-MoHLab results sharing

KeyHIE – Pennsylvani

a

CHINA-ShanghaiImaging Info Sharing

JAPAN-NagoyaImaging Info Sharing

South Africa

MalaysiaSingapore

VITL-Vermont

CareSpark – TN & VA

NetherlandAmsterdam

LowerAustria

Austria

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Where are Public Health Interests Where are Public Health Interests Addressed in IHE?Addressed in IHE?

New Domain: Quality, Research, and New Domain: Quality, Research, and Public HealthPublic Health

Leverages profile initiatives from Leverages profile initiatives from multiple domainsmultiple domains

Current Domain Initiatives in:Current Domain Initiatives in:

IHE Quality, Research, and Public HealthIHE Quality, Research, and Public Health

IHE Patient Care CoordinationIHE Patient Care Coordination

IHE IT InfrastructureIHE IT Infrastructure

QRPH White papersQRPH White papersPatient-Level Export of Quality DataPatient-Level Export of Quality Data Identifies a set if IT Infrastructure and Patient Care Identifies a set if IT Infrastructure and Patient Care

Coordination profiles that can be used to retrieve quality data Coordination profiles that can be used to retrieve quality data from multiple systems for quality reporting and aggregation. from multiple systems for quality reporting and aggregation. This framework can be extended to research and public health This framework can be extended to research and public health purposespurposes

White Paper: Performance Measurement Data White Paper: Performance Measurement Data Element Structured for EHR ExtractionElement Structured for EHR Extraction Intended to identify a standard mechanism to enable Intended to identify a standard mechanism to enable

extraction of quality measures from Electronic Health Record extraction of quality measures from Electronic Health Record SystemsSystems

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QRPH ProfilesQRPH ProfilesClinical Research Data Capture (CRD)Clinical Research Data Capture (CRD) CRD describes the content and format to be used within the Pre-CRD describes the content and format to be used within the Pre-

population Data transaction described within the RFD Integration Profile. population Data transaction described within the RFD Integration Profile. The purpose of this profile is to support a standard set of data in CCD The purpose of this profile is to support a standard set of data in CCD format which the Form Filler provides for use in Clinical Researchformat which the Form Filler provides for use in Clinical Research

Drug Safety Content Profile (DSC) Drug Safety Content Profile (DSC) DSC describes the content and format to be used within the Pre-DSC describes the content and format to be used within the Pre-

population Data transaction described within the RFD Integration Profile. population Data transaction described within the RFD Integration Profile. The purpose of this profile is to support a standard set of data in CCD The purpose of this profile is to support a standard set of data in CCD format which the Form Filler provides for use in reporting adverse events format which the Form Filler provides for use in reporting adverse events as it relates to Drug Safety. as it relates to Drug Safety.

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IHE PCC ProfilesIHE PCC Profiles

Medical Summaries(C48)

ED Referral

ExchangingPHR

Content

(C32)

AntepartumCare

Summary

EmergencyDepartmentEncounter Summary

(C28)

FunctionalStatus

Assessments

2005-062005-062006-072006-072007-082007-082008-092008-09

Inte

gra

tio

nC

on

ten

t

Query for Existing Data

(TP21)

Care Management

AntepartumRecord

ImmunizationRegistryContent

(C78)

CancerRegistryContent

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Query for Existing DataQuery for Existing DataValue PropositionValue Proposition

Exchange of information between Data Repositories and Exchange of information between Data Repositories and Clinical Data Consumers for:Clinical Data Consumers for: Drug SafetyDrug Safety Public Health, Biosurveillance and Disease RegistriesPublic Health, Biosurveillance and Disease Registries Identifying Qualifying PatientsIdentifying Qualifying Patients

• Clinical TrialsClinical Trials• Disease ManagementDisease Management

Quality ReportingQuality Reporting Claims SubmissionClaims Submission

Using a single standard for query Using a single standard for query

Compatible with CCDCompatible with CCD

vs.vs.

30-60 HL7 V2.X Interfaces @ $10-20K/Inteface30-60 HL7 V2.X Interfaces @ $10-20K/Inteface

HITSP TP21, QualityHITSP TP21, Quality

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Immunization ContentImmunization ContentValue PropositionValue Proposition

The value of Immunization Information Systems (IISs) improves as The value of Immunization Information Systems (IISs) improves as the patient immunization histories it maintains become more the patient immunization histories it maintains become more complete.complete.

Although IIS use by public health and safety net providers is Although IIS use by public health and safety net providers is widespread, IISs are challenged to obtain electronic interfaces to widespread, IISs are challenged to obtain electronic interfaces to provider EMRsprovider EMRs

EMR implementers spend 10-20K per year per HL7 V2 connection EMR implementers spend 10-20K per year per HL7 V2 connection

Connections tend to be one-off in spite of HL7 V2 standards and Connections tend to be one-off in spite of HL7 V2 standards and the existence of implementation guides.the existence of implementation guides.

The trend is toward unified HL7 V3 XML-based interactions The trend is toward unified HL7 V3 XML-based interactions including Continuity of Care Document (CCD) and compatible V3 including Continuity of Care Document (CCD) and compatible V3 document standardsdocument standards

Immunization Content strives to provide a bridge between Version Immunization Content strives to provide a bridge between Version 2 and Version 32 and Version 3

HITSP C78, Immunization and Response ManagementHITSP C78, Immunization and Response Management

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Cancer Registry Pathology ReportCancer Registry Pathology ReportValue PropositionValue Proposition

~ 2 Million cancers diagnosed each year in the US~ 2 Million cancers diagnosed each year in the US ~ 95% of these cancers have one or more pathology reports~ 95% of these cancers have one or more pathology reports

The US federally mandates reporting The US federally mandates reporting serves as the foundation to reduce illness and death from cancer serves as the foundation to reduce illness and death from cancer

Making use of the EHR and IHE methodology Making use of the EHR and IHE methodology reduce time and resources required to meet federal mandates reduce time and resources required to meet federal mandates improve the timeliness of reportingimprove the timeliness of reporting

Being proposed to IHE Pathology for 2009Being proposed to IHE Pathology for 2009

NEW DIRECTIONS DEMONSTRATIONNEW DIRECTIONS DEMONSTRATION

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Care ManagementCare ManagementScopeScope

Capability to specify care guidelines and gather Capability to specify care guidelines and gather pertinent information for:pertinent information for:

Public HealthPublic Health Cancer RegistriesCancer Registries Immunization Information Systems (Registries)Immunization Information Systems (Registries) EHR SystemsEHR Systems

Chronic Disease ManagementChronic Disease Management Care Management SystemsCare Management Systems EHR SystemsEHR Systems Other Health IT SystemsOther Health IT Systems

Content for Newborn Screening and Diabetes Content for Newborn Screening and Diabetes under developmentunder development

Watch for 2010 demonstrationsWatch for 2010 demonstrations

IT Infrastructure Components Supporting Public HealthIT Infrastructure Components Supporting Public Health

Cross-Enterprise Document SharingCross-Enterprise Document Sharing

Cross-Enterprise Document Reliable Interchange (XDR)Cross-Enterprise Document Reliable Interchange (XDR)

Cross-Enterprise Document Media Interchange (XDM)Cross-Enterprise Document Media Interchange (XDM)

Patient Identifier Cross Reference Manager (PIX)Patient Identifier Cross Reference Manager (PIX)

Patient Demographics Supplier (PDQ) Patient Demographics Supplier (PDQ)

Retrieve Form for Data Capture (RFD)Retrieve Form for Data Capture (RFD)

Audit Record Repository (ATNA)Audit Record Repository (ATNA)

Time Server (CT)Time Server (CT)

Personnel White Pages (PWP)Personnel White Pages (PWP)

Cross-Enterprise User Assertion (XUA)Cross-Enterprise User Assertion (XUA)

Cross Community Access (XCA)Cross Community Access (XCA)

Basic Patient Privacy Consents (BPPC)Basic Patient Privacy Consents (BPPC)

Cross-enterprise Sharing of Scanned Documents (XDS-SD)Cross-enterprise Sharing of Scanned Documents (XDS-SD)

Document Digital Signature (DSG)Document Digital Signature (DSG)

• Pediatric DemographicsPediatric Demographics• Expands patient demographics for PIX/PDQ to include supported attributes of Expands patient demographics for PIX/PDQ to include supported attributes of

interest to immunization registries interest to immunization registries

• Referral Requests Referral Requests • Addresses a means to a way to convey the referral request in a form suitable Addresses a means to a way to convey the referral request in a form suitable

for automatic processingfor automatic processing• Key to improved coordination of care (e.g. safety-net, under-insured, Key to improved coordination of care (e.g. safety-net, under-insured,

uninsured)uninsured)

• Emergency Contact RegistryEmergency Contact Registry• White paper addressing bridge between the emergency response person White paper addressing bridge between the emergency response person

identification and health record systemsidentification and health record systems• Next of kin contact is a first step in a longer term interoperability initiative in Next of kin contact is a first step in a longer term interoperability initiative in

support of emergency responsesupport of emergency response

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2008 IT Infrastructure Profiles Supporting 2008 IT Infrastructure Profiles Supporting Public HealthPublic Health

• Sharing Value Sets Sharing Value Sets • Addresses synchronization of content terminologies across Addresses synchronization of content terminologies across

applicationsapplications• Key to semantic interoperability for quality, research and public Key to semantic interoperability for quality, research and public

health analysis.health analysis.

• Publish/Subscribe Infrastructure for XDS.b Publish/Subscribe Infrastructure for XDS.b • Currently, required to poll the Document Registry for new Currently, required to poll the Document Registry for new

documents & updatesdocuments & updates• Add support for a publish/subscribe method of receiving new Add support for a publish/subscribe method of receiving new

information for patients of interest.information for patients of interest.• e.g. Public Health Monitoring for certain conditionse.g. Public Health Monitoring for certain conditions• e.g. Subscribe to neighboring state conditions of intereste.g. Subscribe to neighboring state conditions of interest

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2008 IT Infrastructure Profiles Supporting 2008 IT Infrastructure Profiles Supporting Public HealthPublic Health

2008/2009 Development2008/2009 DevelopmentQRPHQRPH Chronic Disease Management Reporting - Profile Chronic Disease Management Reporting - Profile Retrieve Protocol for Execution - ProfileRetrieve Protocol for Execution - Profile Maternal child health - ProfileMaternal child health - Profile Diabetes Care Management - White PaperDiabetes Care Management - White Paper Performance Quality Report - ProfilePerformance Quality Report - Profile New-born screening - Planning White Paper New-born screening - Planning White Paper Pseudonymization - Planning Committee/ITI White PaperPseudonymization - Planning Committee/ITI White Paper

IT InfrastructureIT Infrastructure Publish and Subscribe - ProfilePublish and Subscribe - Profile Multi-Patient Query - ProfileMulti-Patient Query - Profile

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HITSP Support for IHE ConnectathonHITSP Support for IHE ConnectathonFoster development and implementation of the HITSP Foster development and implementation of the HITSP ISsISs Increase awareness of available guidance and supportIncrease awareness of available guidance and support Encourage participation in HITSP Technical CommitteesEncourage participation in HITSP Technical Committees

Ensure 'fitness for use' of HITSP Interoperability Ensure 'fitness for use' of HITSP Interoperability SpecificationsSpecifications DebugDebug Identify improvementsIdentify improvements

Encourage and support vendor application Encourage and support vendor application demonstrations supporting HITSP at the HIMSS demonstrations supporting HITSP at the HIMSS ShowcaseShowcase

HITSP Accepted and Recognized HITSP Accepted and Recognized SolutionsSolutions

IS01 - Electronic Health Records Laboratory Results IS01 - Electronic Health Records Laboratory Results ReportingReporting

IS02 – BiosurveillanceIS02 – Biosurveillance

IS03 - Consumer Empowerment and Access to Clinical IS03 - Consumer Empowerment and Access to Clinical Information via NetworksInformation via Networks

IS04 - Emergency Responder Electronic Health RecordIS04 - Emergency Responder Electronic Health Record

IS05 - Consumer Empowerment and Access to Clinical IS05 - Consumer Empowerment and Access to Clinical Information via MediaInformation via Media

IS06 – QualityIS06 – Quality

IS07 - Medication ManagementIS07 - Medication Management

On The Way (January 2009)On The Way (January 2009)

IS08 - Personalized Healthcare IS08 - Personalized Healthcare

IS09 - Consultation and Transfers of Care  IS09 - Consultation and Transfers of Care 

IS10 - Immunizations and Response IS10 - Immunizations and Response Management Management

IS11 - Public Health Case ReportingIS11 - Public Health Case Reporting

IS12 - Patient - Provider Secure MessagingIS12 - Patient - Provider Secure Messaging

IS77 - Remote MonitoringIS77 - Remote Monitoring

IHE Profiles and HITSP IHE Profiles and HITSP Additional ConstraintsAdditional Constraints

IHE HITSP TitleEDES C28 Emergency Encounter Summary Document

PDQ T23 Patient Demographics Query Transaction

PIX TP22 Patient ID Cross Referencing

XD*Lab C37 Lab Report Document Using IHE XD* Lab Component

XDM T33 Transfer of Documents on Media Transaction

XDS TP13 Manage Sharing of Documents

XDS-MS C38 Patient level quality data document component

XDS-MS C48 Encounter Document Component

XDS-SD C62 Unstructured Document

IHE Profiles and HITSPIHE Profiles and HITSPNo ConstraintsNo Constraints

IHE HITSP TitleATNA T15 Collect and Communicate Audit Trail

ATNA T17 Secured Communication Channel Transaction

BPPC TP30 Manage Consent Directives Transaction Package

CT T16 Consistent Time

DSG C26 Nonrepudiation of Origin Component

NAV T29 Notification of Document Availability Transaction

QED TP21 Query for Existing Data

RFD TP50 Retrieve Form for Data Capture

XDR T31 Reliable Document Exchange

XDS-I TP49/TP89 Sharing Radiology Results Transaction Package

XUA C19 Entity Identity Assertion Component

Panel ApprovedPanel Approved

C64 – PWP – Personnel White PagesC64 – PWP – Personnel White Pages

C78, C72 – Immunization ContentC78, C72 – Immunization Content

T67 – DRR – ReferralT67 – DRR – Referral

C76 – Drug Safety ProfileC76 – Drug Safety Profile

HITSP Population Perspective TC HITSP Population Perspective TC Mondays   1 – 3 PM EST    Quality IS and Measure ConfigurationMondays   1 – 3 PM EST    Quality IS and Measure Configuration StrokeStroke VTEVTE Emergency DepartmentEmergency Department New constructs: QRDA, Clinical Decision SupportNew constructs: QRDA, Clinical Decision Support

Mondays   3 – 4 PM EST    Public Health Case Reporting and Mondays   3 – 4 PM EST    Public Health Case Reporting and Consumer Adverse Event Reporting ( (new extension)new extension) Alert reviewAlert review Data Content Update (Pending CSTE, CDC, AHRQ reports)Data Content Update (Pending CSTE, CDC, AHRQ reports)

Mondays   4 – 5 PM EST    Immunization and Response ManagementMondays   4 – 5 PM EST    Immunization and Response Management Supply Chain ManagementSupply Chain Management Non-vaccine medication administrationNon-vaccine medication administration

Thursday  3 – 4 PM EST    Thursday  3 – 4 PM EST    Newborn Screening ( (new use casenew use case))

Thursday   4 – 5 PM EST    Thursday   4 – 5 PM EST    Maternal and Child Health ( (new extensionnew extension) )

Overview of 2009 Overview of 2009 Population Health ScenariosPopulation Health Scenarios

Alignment with HITSP Use CasesAlignment with HITSP Use Cases IS 02 – BiosurveillanceIS 02 – Biosurveillance IS 06 – QualityIS 06 – Quality IS 10 – Immunization and Response ManagementIS 10 – Immunization and Response Management IS 11 – Public Health Case ReportingIS 11 – Public Health Case Reporting

Quality (above)Quality (above)

Public Health Initiatives in IHEPublic Health Initiatives in IHE Immunization Scenario (same as above)Immunization Scenario (same as above) Cancer Registry – New DirectionsCancer Registry – New Directions

Clinical ResearchClinical Research Drug Safety (also indicated in HITSP Use Case)Drug Safety (also indicated in HITSP Use Case) Clinical TrialsClinical Trials

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ScenariosScenarios

Many of the following scenarios have Many of the following scenarios have specific sponsors driving the demonstration specific sponsors driving the demonstration goalsgoals

Most of the scenarios are still undergoing Most of the scenarios are still undergoing review for clinical accuracyreview for clinical accuracy

Extended technical options are listed, but Extended technical options are listed, but may be adjusted based on capabilitiesmay be adjusted based on capabilities

Some of the scenarios include HITSP Some of the scenarios include HITSP constructs with no IHE equivalentconstructs with no IHE equivalent

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Quality (HITSP IS06)Quality (HITSP IS06)Scene Description Profiles/

Constructs

Specialist Examination and bloodwork for diabetes are assessed and reported for quality measure. Quality reporting content retrieved through QED. Lab Document Published.

XDS, QED, XD*Lab, XDS-MS, C48, C37, TP21

PCP Patient presents to PCP. Diagnosis triggers Quality reporting forms from RFD. Data is populated from data in the EHR and retrieved from the HIE.

XDS, RFD, XD*Lab, XDS-MS, C48, C37, TP50

Hospital Patient is hospitalized with a DVT following surgery. The DVT triggers quality reporting forms from RFD. Data is populated from data in the EHR and retrieved from the HIE.

XDS, RFD, XDS-MS, C48, C37, TP50

Quality Measurement Org

Quality measures are collected and aggregate analysis performed

RFD

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Biosurveillance & Public Health Case Reporting:Biosurveillance & Public Health Case Reporting:Bi-directional Communications (HITSP IS02, IS11)Bi-directional Communications (HITSP IS02, IS11)

Scene Description Profiles/ Constructs

PCP Patient presents to the PCP with Influenza-like-illness symptoms (supports foodborne pathway and influenza pathway). Submits summary of the visit to the HIE. Takes samples and sends to lab for analysis.

EDR, C48

Public Health Lab

Samples are sent to the public health lab for typing revealing …. (multi-drug-resistant strain). Notification is sent to care providers, PH; results posted to XDS;

XD*Lab, NAV, C37, C35, T29

Public Health/HIE

Retrieves data from HIE. Puts data into surveillance system and spike is detected; Alert with specific recommendations is created -- Recommendation may be influenced by lab typing. Forms variant for alerts. Forms and Knowledge service provider reviewed

RFD, NAV, XDS-SD, PWP, C62

PCP Patient presents to PCP. Presenting complaints trigger alert to clinician. Morbidity form is retrieved from PH Server, gets prepopulated from EMR, Clinician adds in additional information and submits to PH (RFD)

RFDTP50, T81, C76

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Immunization (HITSP IS10)Immunization (HITSP IS10)Scene Description Profiles/

Constructs

PCPState 1

Child is immunized in PCP office according to recommended schedule. Submits the immunization document to the HIE. Document is transformed to required 2.3.1 message format via a service gateway

IC, XDS, TP22/T23, C78, TP13

PCPState 2

Parents move to another state and visit new pediatric PCP. PCP queries for records in both affinity domains

IC, XDS, XUA, C78, TP13, C19 TP20

Service Gateway

The gateway transforms immunization document formats to messages enabling IIS a bridge to the HIE

XDS, IC, TP13, C78

School/Public Health

Parents attempt to register child for kindergarten. School nurse/public health nurse looks up immunization information

IC, XDS, XUA, C78, TP13, C19 , TP20

Infrastructure

The infrastructure surrounding the secure information exchange is reviewed

XUA, BPPC, ATNA, TP30, C19, TP20, C15, C1729

IHE Public Health New DirectionsIHE Public Health New DirectionsCancer RegistriesCancer Registries

Scene Description Profiles

Pathology Lab

In the pathology lab, a biopsy sample is analyzed and it is identified as malignant. Pathology report is sent as an electronic submission using traditional HL7 messaging as constrained by IHE for pathology.

Cancer Registry Pre-profile

Hospital Following surgery and follow-up inpatient treatment, Cancer case report form is pre-populated with case reporting data from within the EHR.

RFD, C76

PCP PCP provides follow-up care to the cancer patient. RFD is leveraged with pre-populate capabilities to enable improved reporting from the Physician offices.

RFD, C76

Hospital Patient presents to ED. Hospital retrieves clinical records. Hospital receives generic alerts and case specific alerts from Public health.

XDS, XDS-SD, NAV, C62, C82, T63

Infrastructure

RFD Form management and analysis reviewed. Local registry reporting and analysis reviewed

RFD

Cancer Registry

Public health cancer registry. Electronic reporting and analysis

Cancer Registry pre-profile

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Additional ScenariosAdditional ScenariosClinical Research not Specifically CoveredClinical Research not Specifically Covered

Drug Safety Drug Safety Leveraging IHE Drug Safety Profile as constrained by HITSP. This Leveraging IHE Drug Safety Profile as constrained by HITSP. This

is a late profile and not part of the current connectathon testsis a late profile and not part of the current connectathon tests

Clinical Trials and Drug SafetyClinical Trials and Drug Safety One variant is expected to include Digital Signature as a One variant is expected to include Digital Signature as a

collaborative initiative with CDISC and SAFE Biopharmacollaborative initiative with CDISC and SAFE Biopharma The specific scenario will be generated through efforts between The specific scenario will be generated through efforts between

CDISC and SAFE BiopharmaCDISC and SAFE Biopharma

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HIMSS 2009 HIMSS 2009 Interoperability ShowcaseInteroperability Showcase

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More public health More public health scenariosscenarios

Participation byParticipation byImplementationImplementationTestbedsTestbeds

Security and PolicySecurity and Policy

More content More content available for available for PHIN 2009PHIN 2009

January, 2009 What IHE Delivers33

Questions?Questions?

Lori Reed-Fourquet, Lori Reed-Fourquet, E-HealthSIgnE-HealthSIgn1056 Durham Road1056 Durham RoadWallingford, Ct. 06492Wallingford, Ct. 06492phone: (203)294-0479phone: (203)294-0479Fax: (203) 294-9623Fax: (203) 294-9623e-mail: lori.fourquet@sbcglobal.nete-mail: lori.fourquet@sbcglobal.net